title: Effect of knowledge of community health workers on essential newborn health care: a study from rural India.
abstract: BACKGROUND
  This study explored the relationship between the knowledge of community health workers (CHWs)-anganwadi workers (AWWs) and auxiliary nurse midwives (ANMs)-and their antenatal home visit coverage and effectiveness of the visits, in terms of essential newborn health care practices at the household level in rural India.
  
  
  METHODS
  We used data from 302 AWWs and 86 ANMs and data from recently delivered women (RDW) (n=13,023) who were residents of the CHW catchment areas and gave birth to a singleton live baby during 2004-05. Using principal component analysis, knowledge scores for preventive care and danger signs were computed separately for AWWs and ANMs and merged with RDW data. A multivariate logistic regression model was used to estimate the adjusted effect of knowledge level. A generalized estimating equation (GEE) was used to account for clustering.
  
  
  RESULTS
  Coverage of antenatal home visits and newborn care practices were positively correlated with the knowledge level of AWWs and ANMs. Initiation of breastfeeding in the first hour of life (odds ratio 1.97; 95% confidence interval (CI): 1.55-2.49 for AWW, and odds ratio 1.62; 95% CI: 1.25-2.09 for ANM), clean cord care (odds ratio 2.03; 95% CI: 1.64-2.52 for AWW, and odds ratio 1.43; 95% CI: 1.17-1.75 for ANM) and thermal care (odds ratio 2.16; 95% CI: 1.64-2.85 for AWW and odds ratio 1.88; 95% CI: 1.43-2.48 for ANM) were significantly higher among women visited by AWWs or ANMs who had better knowledge compared with those with poor knowledge.
  
  
  CONCLUSIONS
  CHWs' knowledge is one of the crucial aspects of health systems to improve the coverage of community-based newborn health care programmes as well as adherence to essential newborn care practices at the household level.
authors.affiliation: International Planned Parenthood Federation–South Asia Regional Office (IPPF–SARO), New Delhi, India.
authors.forename: Praween K
authors.initials: PK
authors.lastname: Agrawal
authors.forename: Sutapa
authors.initials: S
authors.lastname: Agrawal
authors.forename: Saifuddin
authors.initials: S
authors.lastname: Ahmed
authors.forename: Gary L
authors.initials: GL
authors.lastname: Darmstadt
authors.forename: Emma K
authors.initials: EK
authors.lastname: Williams
authors.forename: Heather E
authors.initials: HE
authors.lastname: Rosen
authors.forename: Vishwajeet
authors.initials: V
authors.lastname: Kumar
authors.forename: Usha
authors.initials: U
authors.lastname: Kiran
authors.forename: Ramesh C
authors.initials: RC
authors.lastname: Ahuja
authors.forename: Vinod K
authors.initials: VK
authors.lastname: Srivastava
authors.forename: Mathuram
authors.initials: M
authors.lastname: Santosham
authors.forename: Robert E
authors.initials: RE
authors.lastname: Black
authors.forename: Abdullah H
authors.initials: AH
authors.lastname: Baqui
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003150:Community Health Workers; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007194:India; D007231:Infant, Newborn; D016015:Logistic Models; D008875:Middle Aged; D017283:Neonatal Nursing / Q000379:methods*; D012424:Rural Population; D055815:Young Adult